Lecture Notes

The ideal in veterinary oncology is to aim for curative outcomes in the treatment of cancer-bearing patients, however management/control of the disease may be the reality for some, with palliative care being important for ongoing welfare. Cancer therapy can be intense, and there are many treatment options available for our patients, depending on the diagnosis and prognosis. Very often the focus of care is on the body, but what we should also consider the patient’s mind and soul - an area in which Veterinary Nurses can hap a positive impact.

Palliative care may be undertaken for various reasons, e.g., the primary cancer, or its metastases, are too far advanced for definitive treatment; the caregivers wishes, beliefs, and/or finances; the presence of other life-limiting co-morbidities; the patients emotional health/behavioural welfare, etc. Many of the treatment options/standards of care for all types of cancers apply in the palliative setting, for example surgery, chemotherapy, radiotherapy +/- adjunctive treatments to maintain good quality of life - however, the intention and outcome objectives shift from welfare and longevity, to control of clinical signs, maintenance of optimum comfort and an “every day must be a great day” focus, i.e., with minimum “borrow” for maximum “payback” for the patient. Regardless of the reason(s), limitations, or goals, compassionate care of all patients, cancer patients included, requires they are kept as free as possible from the adverse effects of their illnesses and treatment.

Palliative care in cancer patients may take many forms, including monitoring of the primary illness; analgesia management; maintenance of optimal nutritional +/- hydration status; management of co-morbidities; assessment of ongoing therapies; lifestyle modifications, etc. Therefore RVNs are well-placed to surveil for, and provide, key aspects of palliative care in veterinary cancer therapy; as well as being the patient’s advocate, acting as key liaison between the veterinary care team(s), educating and communicating with caregivers, and monitoring day-to-day quality of life and welfare.

With our increasing population of pets living to greater ages, cancer is common - it being mainly condition of older age, and the cause of death in up-to one-in-four patients. Many more (than those that die from cancer) senior pets are living with cancer, and being well-managed, with some other condition being their eventual cause of death. Therefore much of the routine care provided to all senior pets, and/or those with chronic illness, applies to how we can apply our nursing skills to the acute and chronic care of cancer patients, particularly in the palliative care setting.

Palliative care, in which RVNs may be involved, may include:

• Pain and comfort assessment/management - RVNs are key in managing pain, by constant re-evaluation, tailoring of analgesic protocols in liaison with the clinician, communication with caregivers and addressing patients changing needs.
• Treatments such as NSAIDs, corticosteroids, small-molecule-inhibitors, immunotherapy, emerging tailored therapies, adjunctive/complementary therapies and modalities, e.g., acupuncture +/- physiotherapy.
• Also, often chemotherapy +/- radiotherapy
• Ongoing monitoring of whole-patient health and welfare.
• Nutritional advice/intervention where appropriate. Meeting clinical nutritional requirements is important in cancer care. Caregivers often need assistance with this too.
• Feeding tube placement and management; dietary calculations and tube care; caregiver instruction on tube use/care.

Veterinary nurses may also facilitate palliative care via wellness clinics, aimed at keeping cancer-bearing pets enjoying great, long-term quality of life, and guiding caregivers through their cancer journey - from a clinical and non-clinical perspective. Taking a holistically patient-centred approach to all aspects of cancer nursing can make a real difference to the lives of caregivers and their cancer-bearing pets across aspects of our nursing care for these very special patients, tailoring what we do and how we do it to patient and human-animal relationship.

References

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